Background/Purpose: For patients with rheumatoid arthritis (RA), making treatment decisions can be overwhelming. The literature describes a sense of ambivalence among patients with chronic diseases toward medication use. For people considering methotrexate (MTX) for RA, we have developed a web-based decision aid called ANSWER. It consists of six animated patient stories and narrated information on the evidence of MTX for RA, and questionnaires to clarify individuals’ treatment preferences. ANSWER asks patients to consider two options: 1) take MTX as prescribed, or 2) discuss options other than MTX with their doctors. At the end of the program, it produces a one-page summary with the patient’s preferred treatment choices and questions, which can be presented to the doctor at the next medical visit. The current study aimed to understand patients’ experiences with this new MTX decision aid.

Methods:   This qualitative study was conducted within a proof-of-concept study on the ANSWER. Individuals were recruited from rheumatologists’ clinics, patient groups and social networking sites. Eligible participants were those who had been diagnosed with RA, had been prescribed MTX but were unsure about starting it, and with access to the internet. Of the 30 participants enrolled, 11 were randomly selected to participate in an in-depth telephone interview on 3 broad topics: 1) their experience with the ANSWER, 2) their use of the Internet for health information, and 3) their views on disseminating the ANSWER to others with RA. We conducted thematic content analysis to understand their experiences.

Results:    Eight women and 3 men, aged 31 to 65 years, were interviewed. All participants were MTX naïve at the time of enrolment, with disease duration from less than 1 week to 16 years. Of the 11 participants, 7 were able to make a decision after using ANSWER, and 4 remained unsure. Our analysis identified 3 main themes: 1) Seeking confirmation: regardless of their prior level of knowledge on RA and MTX, participants constantly compared what they learnt from ANSWER and sought confirmation with their own knowledge, even some of which was inaccurate. 2) Amplifying reluctance: while using ANSWER, participants’ doubts about using MTX increased when they encountered information that did not align with their own experience with the disease. 3) Clarifying thoughts: By completing the ANSWER’s preference clarification questionnaire, some participants were able to reach the ‘best option’ for them. Several participants commented that ANSWER legitimized the practice of asking questions during medical visits and advocating for themselves.

Conclusion:   Our preliminary findings highlight the power of patients’ prior knowledge and experiences with RA on how they approach the information presented in a decision aid. This suggests that decision aids should address myths about RA, in addition to presenting the evidence of treatment options. Moreover, as the ANSWER serves only to initiate the discussion between patients and their doctors about MTX, further strategies are needed to support ongoing patient-doctor communication during medical visits.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/exploring-how-patients-with-rheumatoid-arthritis-use-a-methotrexate-decision-aid-for-making-treatment-choices/